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Clinical significance of the bronchodilator response in children with severe asthma
Author(s) -
Coverstone Andrea M.,
Bacharier Leonard B.,
Wilson Bradley S.,
Fitzpatrick Anne M.,
Teague William Gerald,
Phipatanakul Wanda,
Wenzel Sally E.,
Gaston Benjamin M.,
Bleecker Eugene R.,
Moore Wendy C.,
Ramratnam Sima,
Jarjour Nizar N.,
Ly Ngoc P.,
Fahy John V.,
Mauger David T.,
Schechtman Kenneth B.,
YinDeClue Huiqing,
Boomer Jonathan S.,
Castro Mario
Publication year - 2019
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24473
Subject(s) - medicine , asthma , spirometry , bronchodilator , odds ratio , confidence interval , exhaled nitric oxide , bronchodilation , wheeze , vital capacity , lung function , lung , diffusing capacity
Background Our objective was to determine those characteristics associated with reversibility of airflow obstruction and response to maximal bronchodilation in children with severe asthma through the Severe Asthma Research Program (SARP). Methods We performed a cross‐sectional analysis evaluating children ages 6 to 17 years with nonsevere asthma (NSA) and severe asthma (SA). Participants underwent spirometry before and after 180 µg of albuterol to determine reversibility (≥12% increase in FEV 1 ). Participants were then given escalating doses up to 720 µg of albuterol to determine their maximum reversibility. Results We evaluated 230 children (n = 129 SA, n = 101 NSA) from five centers across the United States in the SARP I and II cohorts. SA (odds ratio [OR], 2.08, 95% confidence interval [CI], 1.05‐4.13), second‐hand smoke exposure (OR, 2.81, 95%CI, 1.23‐6.43), and fractional exhaled nitric oxide (FeNO; OR, 1.97, 95%CI, 1.35‐2.87) were associated with increased odds of airway reversibility after maximal bronchodilation, while higher prebronchodilator (BD) FEV 1 % predicted (OR, 0.91, 95%CI, 0.88‐0.94) was associated with decreased odds. In an analysis using the SARP III cohort (n = 186), blood neutrophils, immunoglobulin E (IgE), and FEV 1 % predicted were significantly associated with BD reversibility. In addition, children with BD response have greater healthcare utilization. BD reversibility was associated with reduced lung function at enrollment and 1‐year follow‐up though less decline in lung function over 1 year compared to those without reversibility. Conclusions Lung function, that is FEV 1 % predicted, is a predictor of BD response in children with asthma. Additionally, smoke exposure, higher FeNO or IgE level, and low peripheral blood neutrophils are associated with a greater likelihood of BD reversibility. BD response can identify a phenotype of pediatric asthma associated with low lung function and poor asthma control.